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Overview: Twirla is a birth control patch used to help prevent pregnancy. Twirla does not protect against HIV/AIDS or sexually transmitted infections. Common side effects include redness or irritation at the patch application site, nausea, and painful periods. Each patch must stay on your skin for 7 days for it to work the best. Talk with your health care provider if you forget to replace a patch or a patch becomes loose or falls off.

Uses

What is Twirla used for?

Twirla is a combination birth control medicine used to prevent pregnancy in women. Twirla contains 2 types of hormones: levonorgestrel (a progestin) and ethinyl estradiol (an estrogen).

Twirla may also be used for other conditions as determined by your health care provider.

How does Twirla work (mechanism of action)?

Twirla works for pregnancy prevention in a few ways. Twirla works mainly to stop ovulation. Twirla also works to change your cervical mucus to prevent sperm cells from entering your uterus and causes changes in the tissue that lines the uterus (endometrium), which reduces the chance of a fertilized egg implanting in your uterus. 

How is Twirla supplied (dosage forms)?

Brands and other names

  • Twirla

Dosage forms and strengths

  • 120 mcg/day levonorgestrel/30 mcg/day ethinyl estradiol transdermal system

How should I store Twirla?

Twirla should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C), for shorter periods of time, such as when transporting it. Do not store Twirla in the refrigerator or freezer. Keep the medicine in the original unopened pouch. 

Side Effects

What are the most common side effects of Twirla?

The most common side effects of Twirla are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Pain, itching, swelling, or redness at the patch application site 
  • Nausea
  • Headache
  • Painful periods
  • Weight gain

There may be other side effects of Twirla that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of Twirla?

While less common, the most serious side effects of Twirla are described below, along with what to do if they happen.

Severe Allergic Reactions. Twirla may cause allergic reactions, which can be serious. Stop using Twirla and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Blood Clots. Twirla may cause blood clots in your veins or arteries and could cause venous thromboembolism (VTE), stroke, heart attack, a blood clot in the lungs (pulmonary embolism), or a blood clot in the eyes. Stop using Twirla and get emergency help right away if you have any of the following signs of blood clots. 

  • Chest pain or pressure
  • Fast or abnormal heartbeat
  • Trouble breathing
  • Pain in your back, jaw, throat, or arm
  • Sweating, upset stomach, vomiting, or dizziness
  • Sudden weakness on one side of your body
  • Sudden and severe headache
  • Slurred speech or trouble understanding speech
  • Pain, swelling, or tenderness in your arm or leg
  • Vision loss
  • Bulging eyes 
  • Double vision

Increased Blood Pressure (Hypertension). Twirla may increase your blood pressure or make it worse if you have a history of high blood pressure. Stop using Twirla and call your health care provider if your blood pressure increases significantly while using this medicine.

If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, stop using Twirla and get medical attention right away. Increases in blood pressure may not be noticeable but look out for any of the following symptoms of severely high blood pressure.

  • Sudden severe headache
  • Chest pain
  • Dizziness or confusion
  • Trouble breathing
  • Nausea/vomiting
  • Blurry or other changes to vision
  • Anxiety
  • Buzzing in the ears
  • Nosebleed
  • Feeling of skipped heart beats

Liver Problems. Twirla may cause changes to your liver function including liver tumors and an increase in your liver enzymes. Your health care provider may monitor your liver function while you are using Twirla. Stop using Twirla and call your health care provider if you have severe stomach pain or stomach tenderness. Call your health care provider if you have any of the following symptoms of liver problems.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Headache/Migraine. Stop using Twirla and call your health care provider right away if you develop new headaches/migraines that keep coming back or cause you a lot of pain.

Depression. Twirla may cause changes in mood, including depression. Stop using Twirla and call your health care provider right away if you have new or increased depression or other unusual changes in mood or behavior. 

Cancer. Twirla is a combination birth control pill that contains two hormones. Certain cancers, including breast cancer and cervical cancer are types of cancers that may be sensitive to hormones. Make sure you keep all appointments with your health care provider.

Warnings & Precautions

Who should not use Twirla?

Allergies to Ingredients. People who are allergic to any of the following should not use Twirla.

  • Levonorgestrel
  • Ethinyl estradiol
  • Twirla
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in Twirla.

Drug Interactions. Twirla should not be used while you are using certain other medicines. Before using Twirla, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. Do not use Twirla if you are pregnant. If you become pregnant, contact your health care professional right away. See the Pregnancy section for more details.

Smoking. Twirla should not be used if you smoke and are 35 years of age or older, as this can increase your chances of having a heart attack, stroke, or blood clots.

History of Blood Clots. Twirla should not be used if you currently have or have had deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, or heart attack.

Blood and Blood Vessel Problems. Twirla should not be used if you have a condition that makes your blood more prone to getting blood clots (hypercoagulation or thrombophilia). Twirla should not be used if you have or have had a history of plaque buildup in your blood vessels (coronary artery disease) or if you have or have had a condition that affects the blood flow to your brain (cerebrovascular disease). 

Heart Problems. Twirla should not be used if you have heart rhythm problems (such as atrial fibrillation) or heart valve problems, as this may increase your chances of having a blood clot.

Increased Blood Pressure (Hypertension). Twirla should not be used if you have high blood pressure that is not controlled or high blood pressure with a condition that affects your blood vessels (vascular disease).

Diabetes. Twirla should not be used if you have diabetes and are over the age of 35, have high blood pressure, or have kidney, eye, nerve, or blood vessel damage. Twirla should also not be used if you have had diabetes for more than 20 years.

Headaches/Migraines. Twirla should not be used if you have migraines with vision or hearing changes, muscle weakness, tingling, or trouble speaking (aura) or certain types of headaches, as this can increase your risk of having a stroke. Twirla should not be used if you are 35 or older with migraine headaches (with or without aura). 

Liver Problems. Twirla should not be used if you have tumors on your liver, acute hepatitis (inflammation of the liver), decompensated cirrhosis (scar tissue on your liver), or liver disease.

Spotting. Twirla should not be used if you are bleeding between your monthly periods without any specific causes. Tell your health care provider if you are bleeding between your monthly periods while on Twirla. Your health care provider will find out why this is happening and may do tests to determine if you are able to use this medicine.

Cancer. Twirla should not be used if you have or have had breast cancer or have endometrial cancer.

Jaundice. Twirla should not be used if you have had a history of jaundice when using birth control or have had cholestatic jaundice during pregnancy (bile from the liver not flowing properly).

Major Surgeries. Twirla should not be used if you are undergoing a major surgery and will be unable to move normally for a long period of time. Your health care provider may ask you to stop using Twirla at least four weeks before your surgery and may wait at least two weeks after your surgery to start you on Twirla. If your health care provider decides to stop Twirla because of an upcoming surgery, your health care provider will talk to you about other forms of contraception to use during that time.

Weight. Twirla should not be used if you have a body mass index (BMI) greater than or equal to 30 kg/m2. A BMI of at least 30 kg/m2 may affect how well Twirla works and may increase your chances of having a venous thromboembolism. Your health care provider will calculate your BMI to see if you can use Twirla.

What should I know about Twirla before using it?

Do not use Twirla unless it has been prescribed to you by a health care provider. Use it as prescribed. 

Do not share Twirla with other people, even if they have the same condition as you. It may harm them.

Keep Twirla out of the reach of children.

Twirla does not protect against human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), or other sexually transmitted infections (STIs).

Follow the Instructions for Use that comes with the medicine to learn how to use Twirla. Make sure that you remove the old patch before applying a new one. Each Twirla patch is worn for seven days (one week). The patch must be fully attached for the entire week for it to work the best. Do not cut the Twirla patch, as it may not work as well. 

Twirla can be applied on the lower stomach, butt, or upper torso (except the breasts). Do not use creams, lotions, makeup, oils, powders, or any other products on the area of skin you put the patch on. This may make it hard for the patch to stay on your skin. Swimming or contact with water often or for 30 minutes or longer may also affect how the patch stays on your skin. If the patch falls off or becomes loose, follow the Instructions for Use that comes with the medicine. Talk to your health care provider if you are unsure what to do if a patch becomes loose or falls off.

To throw away Twirla, fold the sticky sides of the patch together, place the patch in a sturdy container, and place the container (with the patch) in the trash. Do not flush used patches down the toilet.

Talk to your health care provider about backup birth control options (condoms, spermicide). 

Your periods may be irregular, lighter, and/or shorter than usual while you are using Twirla. If you miss your period and have not used Twirla as directed, call your health care provider right away.

What should I tell my health care provider before using Twirla?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if Twirla is right for you.

In particular, make sure that you discuss any of the following.

Immobilization. Talk to your health care provider if you are unable to walk for an extended period of time (immobile). Using Twirla while you are immobile may increase your risk of having blood clots.

Gallbladder Problems. Tell your health care provider if you have or have had gallbladder problems, including jaundice, cholestasis (slowed flow of bile from the liver), or a history of cholestasis, especially during pregnancy. Using Twirla can increase your chances of having cholestasis, which can increase your chances of having jaundice, and may worsen your gallbladder problems.

Skin Issues. Talk to your health care provider if you have had a condition that led to dark patches of skin around your forehead, nose, cheeks, and around your mouth (chloasma), especially during pregnancy  because you may have an increased chance of having chloasma while using Twirla. If you have had chloasma, avoid exposure to the sun and to ultraviolet (UV) rays from tanning booths or sun lamps.

Angioedema. Talk to your health care provider if you have a condition called hereditary angioedema that leads to swelling in different parts of your body including your lips, face, tongue, or throat. Using Twirla  may increase your chances of having angioedema or make your angioedema symptoms worse if you have a history of angioedema. 

Depression. Talk to your health care provider if you have a history of depression. Using Twirla may worsen depression.

Diabetes. Tell your health care provider if you have prediabetes or diabetes. Twirla may increase your blood sugar.

High Triglycerides. Tell your health care provider if you have high triglyceride levels or you have a family history of high triglyceride levels, as using Twirla may cause an increase in your triglyceride levels and may increase your chances of having pancreatitis. Your health care provider will decide if you should use Twirla.

Pregnancy. Do not use Twirla and tell your health care provider if you are pregnant or plan to become pregnant. If you become pregnant, stop using Twirla right away and contact your health care provider.

Breastfeeding. Twirla passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Twirla may decrease the amount of breast milk you make. Your health care provider will advise you if you should use Twirla while breastfeeding. 

How can I get more information about Twirla?

For more information about Twirla, you can visit the drugmaker’s website at www.Twirla.com or call them at 855-389-4752.

Interactions

Does Twirla interact with foods or drinks?

Eating grapefruit or drinking grapefruit juice while using Twirla can increase the level of ethinyl estradiol in your body. Talk to your health care provider if you eat grapefruit or drink grapefruit juice. Your health care provider will tell you if you can eat grapefruit/drink grapefruit juice while using Twirla.

There are no known interactions between Twirla and alcohol.

Does Twirla interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using Twirla.

  • Aprepitant, which is a medicine used to prevent nausea and vomiting 
  • A barbiturate, such as phenobarbital, butalbital, or primidone, which is a medicine that may be used to treat insomnia, migraines, or seizures
  • Bosentan, which is a medicine used to treat a condition called pulmonary arterial hypertension (PAH)
  • Carbamazepine (Tegretol, Carbatrol, and others), which is a medicine used to control seizures and treat nerve pain
  • Griseofulvin, itraconazole, voriconazole, fluconazole, or ketoconazole, which is a medicine used to treat certain types of fungal infections
  • Phenytoin (Dilantin, Phenytek, and others), felbamate, oxcarbazepine (Trileptal, Oxtellar XR), rufinamide, or lamotrigine, which is a medicine to control seizures
  • Rifampin, which is a medicine commonly used to treat an infection called tuberculosis
  • Rifabutin (Mycobutin), which is a medicine used to prevent Mycobacterium avium complex infection 
  • Topiramate (Topamax, Trokendi XR, Qudexy XR), which is a medicine commonly used to treat seizures or prevent migraine
  • St. John’s wort, which is a supplement that may be used to treat depression
  • A medicine for HIV, AIDS, or hepatitis C
  • Atorvastatin (Lipitor and others), rosuvastatin (Crestor), or colesevelam (Welchol), which is a medicine used for high cholesterol
  • Vitamin C (ascorbic acid), which is a supplement that may used to treat/prevent low vitamin C levels
  • Acetaminophen (Tylenol), which is used to treat pain and fever
  • A thyroid medicine, such as levothyroxine, which is used to raise thyroid hormone levels
  • A corticosteroid, which is a medicine for certain inflammatory conditions
  • Morphine, which is used to treat certain types of pain
  • Temazepam, which is a medicine used to treat insomnia
  • Cyclosporine (Gengraf, Neoral, Sandimmune, and others), which is a medicine to suppress your immune system
  • Theophylline (Elixophyllin, Theo-24), which is a medicine for asthma or certain other breathing problems
  • Tizanidine (Zanaflex), which is a muscle relaxant

Some other medicines may alter the blood levels of Twirla, and vice versa. This can cause Twirla to not work as well, may cause bleeding between your monthly periods, or higher than normal levels of hormones in your body. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with Twirla. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much Twirla?

If you or someone else has used too much Twirla, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of Twirla?

Twirla may not work as it should if you forget to remove and replace the patch. Follow the Instructions for Use on how to use Twirla. What you need to do can change depending on when you forgot to replace the patch.